Rifampin: Difference between revisions
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==General== | ==General== | ||
*Type: | *Type: bactericidal [[antibiotic]] | ||
*Dosage Forms: | *Dosage Forms: 150, 300; PO, IV | ||
*Common Trade Names: | *Common Trade Names: Rifadin | ||
==Pharmacology== | |||
*Half-life: 1.5-5hours (increased if there is hepatic dysfunction) | |||
**Rifampin autoinduces its own metabolism so half-life is decreased with subsequent dosing. | |||
*Metabolism: Hepatic | |||
*Excretion: Bile; Urine <30% | |||
*Mechanism of Action: inhibits bacterial RNA synthesis | |||
==Adult Dosing== | ==Adult Dosing== | ||
===Active [[TB]]=== | |||
*10mg/kg/day (in combination with [[isoniazid]] and [[pyrazinamide]]) PO or IV for 2 months | |||
**Then 10mg/kg/day (in combination with [[isoniazid]]) for 4 months or longer as needed | |||
**MAX, 600mg/day | |||
===Inactive [[TB]], HIV+=== | |||
*600mg PO daily for 4 months | |||
===[[Meningitis]]=== | |||
*600mg IV once daily (with [[vancomycin]]/[[cephalosporin]]) | |||
===[[Neisseria meningitidis|Meningococcal Prophylaxis]]=== | |||
*600 mg PO BID for two days | |||
===Bartonellosis=== | |||
*300mg PO or IV q12h plus [[doxycycline]] | |||
===Brucellosis=== | |||
*15-20mg/kg/day PO/IV in 1 or 2 divided doses for at least 6 weeks in combination with a [[tetracycline]] | |||
**MAX 600 to 900mg/day | |||
===Infective endocarditis=== | |||
*300mg IV or PO every 8 hours for a minimum of 6 weeks, in combination with appropriate antimicrobial therapy | |||
===Hansen Disease=== | |||
*Paucibacillary, single lesion | |||
**600 mg PO x1 with [[ofloxacin]] and [[minocycline]] | |||
*Paucibacillary | |||
**600 mg PO qmo x 6mo with [[dapsone]] | |||
*Multibacillary | |||
**600 mg PO qmo x 12mo with [[dapsone]] and [[clofazimine]] | |||
===[[Anthrax]], systemic=== | |||
*600 mg IV q12h for at least 2 wk as part of a multi-drug regimen | |||
**Switch to PO abx x60 days total if inhalational exposure | |||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
===Active [[TB]]=== | |||
*<15 yo | |||
**10-20 mg/kg PO/IV qd for at least 6mo | |||
***Max: 600 mg/day | |||
*15+ yo | |||
**10 mg/kg PO/IV qd for at least 6mo | |||
***Max: 600 mg/day | |||
===Latent [[TB]]=== | |||
*<15 yo | |||
**10-20 mg/kg PO/IV qd x4mo | |||
***Max: 600 mg/day | |||
*15+ yo | |||
**10 mg/kg PO/IV qd x4mo | |||
***Max: 600 mg/day | |||
===[[H. influenza]] prophylaxis=== | |||
*<1 mo | |||
**10mg/kg PO/IV q24h x4 days | |||
***Max: 600 mg/day | |||
*1+ mo | |||
**20 mg/kg PO/IV q24h x4 days | |||
**Max: 600 mg/day | |||
===Meningcococcal prophylaxis=== | |||
*<1 mo | |||
**5mg/kg PO/IV q24h x4 days | |||
***Max: 600 mg/day | |||
*1+ mo | |||
**10 mg/kg PO/IV q24h x4 days | |||
**Max: 600 mg/day | |||
===[[Endocarditis]], Staphylococcal prosthetic valve=== | |||
*20 mg/kg/day PO/IV divided q8h for at least 6wk with [[gentamicin]] and [[nafcillin]] | |||
**Max 900 mg/day | |||
===Hansen Disease=== | |||
*Paucibacillary, 10-14 yo | |||
**450mg PO qmo x6mo with [[dapsone]] | |||
*Paucibacillary, 15+ yo | |||
**600 mg PO qmo x 6mo with [[dapsone]] | |||
*Multibacillary, 10-14 yo | |||
**450mg PO qmo x 12mo with [[dapsone]] and [[clofazimine]] | |||
*Multibacillary, 15+ yo | |||
**600 mg PO qmo x 12mo with [[dapsone]] and [[clofazimine]] | |||
===[[Anthrax]], systemic=== | |||
*Neonates >32 wk gestation | |||
**10-20 mg/kg/day IV divided q12-24h for at least 2 wk as part of multi-drug regimen | |||
*1+ mo | |||
**20 mg/kg/day IV divided q12h for at least 2 wk as part of multi-drug regimen | |||
***Max: 300 mg/dose | |||
==Special Populations== | ==Special Populations== | ||
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: | *[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C | ||
*Lactation: | *Lactation: Infant risk minimal | ||
*Renal Dosing | *Renal Dosing: | ||
**Adult | **Adult | ||
***CrCl <50: Consider decreasing dose 0-50% | |||
***HD/PD: No supplment | |||
**Pediatric | **Pediatric | ||
***CrCl <50: Consider decreasing dose 0-50% | |||
***HD/PD: No supplment | |||
*Hepatic Dosing | *Hepatic Dosing | ||
**Adult | **Adult | ||
***Avoid Use | |||
**Pediatric | **Pediatric | ||
***Avoid Use | |||
==Contraindications== | ==Contraindications== | ||
*Allergy to class/drug | *Allergy to class/drug | ||
*IM or SC administration | |||
*Concomitant use with atazanavir, darunavir, fosamprenavir, saquinavir, tipranavir, rilpivirine or elvitegravir/cobicistat | |||
==Adverse Reactions== | ==Adverse Reactions== | ||
===Serious=== | ===Serious=== | ||
*[[Agranulocytosis]] | |||
*[[DIC]] | |||
*Hepatotoxicity | |||
*Nephrotoxicity | |||
*[[Thrombocytopenia]] | |||
*[[Leukopenia]] | |||
*[[Anemia]] | |||
*Porphyria exacerbation | |||
*Erythema multiforme | |||
*[[Stevens-Johnson Syndrome]] | |||
*Toxic epidermal necrolysis | |||
*C. Diff associated diarrhea | |||
*Psychosis | |||
*[[Uveitis]] | |||
===Common=== | ===Common=== | ||
*Reddish-Orange body fluids | |||
*[[Nausea]]/[[vomiting]] | |||
*[[Diarrhea]] | |||
*[[Headache]] | |||
*[[Dizziness]] | |||
*[[Fatigue]] | |||
*Disequilibrium | |||
*Weakness | |||
*[[Pruritus]] | |||
*Flushing | |||
*Anorexia | |||
*[[Abdominal pain]] | |||
*[[Dyspnea]] | |||
*Contact lens staining | |||
== | ==Acute Overdose== | ||
* | *Diarrhea is unique to rifampin toxicity in comparison to other antituberculous medications<ref>Broadwell R. et al. Suicide by rifampin overdose. JAMA. 1978; 240:2283.13.</ref> | ||
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>== | ==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>== | ||
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===Key=== | ===Key=== | ||
{{Template:Antibacterial Spectra Key}} | {{Template:Antibacterial Spectra Key}} | ||
==See Also== | ==See Also== | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:Pharmacology]] | [[Category:Pharmacology]] | ||
[[Category:ID]] |
Latest revision as of 08:00, 21 January 2022
General
- Type: bactericidal antibiotic
- Dosage Forms: 150, 300; PO, IV
- Common Trade Names: Rifadin
Pharmacology
- Half-life: 1.5-5hours (increased if there is hepatic dysfunction)
- Rifampin autoinduces its own metabolism so half-life is decreased with subsequent dosing.
- Metabolism: Hepatic
- Excretion: Bile; Urine <30%
- Mechanism of Action: inhibits bacterial RNA synthesis
Adult Dosing
Active TB
- 10mg/kg/day (in combination with isoniazid and pyrazinamide) PO or IV for 2 months
- Then 10mg/kg/day (in combination with isoniazid) for 4 months or longer as needed
- MAX, 600mg/day
Inactive TB, HIV+
- 600mg PO daily for 4 months
Meningitis
- 600mg IV once daily (with vancomycin/cephalosporin)
Meningococcal Prophylaxis
- 600 mg PO BID for two days
Bartonellosis
- 300mg PO or IV q12h plus doxycycline
Brucellosis
- 15-20mg/kg/day PO/IV in 1 or 2 divided doses for at least 6 weeks in combination with a tetracycline
- MAX 600 to 900mg/day
Infective endocarditis
- 300mg IV or PO every 8 hours for a minimum of 6 weeks, in combination with appropriate antimicrobial therapy
Hansen Disease
- Paucibacillary, single lesion
- 600 mg PO x1 with ofloxacin and minocycline
- Paucibacillary
- 600 mg PO qmo x 6mo with dapsone
- Multibacillary
- 600 mg PO qmo x 12mo with dapsone and clofazimine
Anthrax, systemic
- 600 mg IV q12h for at least 2 wk as part of a multi-drug regimen
- Switch to PO abx x60 days total if inhalational exposure
Pediatric Dosing
Active TB
- <15 yo
- 10-20 mg/kg PO/IV qd for at least 6mo
- Max: 600 mg/day
- 10-20 mg/kg PO/IV qd for at least 6mo
- 15+ yo
- 10 mg/kg PO/IV qd for at least 6mo
- Max: 600 mg/day
- 10 mg/kg PO/IV qd for at least 6mo
Latent TB
- <15 yo
- 10-20 mg/kg PO/IV qd x4mo
- Max: 600 mg/day
- 10-20 mg/kg PO/IV qd x4mo
- 15+ yo
- 10 mg/kg PO/IV qd x4mo
- Max: 600 mg/day
- 10 mg/kg PO/IV qd x4mo
H. influenza prophylaxis
- <1 mo
- 10mg/kg PO/IV q24h x4 days
- Max: 600 mg/day
- 10mg/kg PO/IV q24h x4 days
- 1+ mo
- 20 mg/kg PO/IV q24h x4 days
- Max: 600 mg/day
Meningcococcal prophylaxis
- <1 mo
- 5mg/kg PO/IV q24h x4 days
- Max: 600 mg/day
- 5mg/kg PO/IV q24h x4 days
- 1+ mo
- 10 mg/kg PO/IV q24h x4 days
- Max: 600 mg/day
Endocarditis, Staphylococcal prosthetic valve
- 20 mg/kg/day PO/IV divided q8h for at least 6wk with gentamicin and nafcillin
- Max 900 mg/day
Hansen Disease
- Paucibacillary, 10-14 yo
- 450mg PO qmo x6mo with dapsone
- Paucibacillary, 15+ yo
- 600 mg PO qmo x 6mo with dapsone
- Multibacillary, 10-14 yo
- 450mg PO qmo x 12mo with dapsone and clofazimine
- Multibacillary, 15+ yo
- 600 mg PO qmo x 12mo with dapsone and clofazimine
Anthrax, systemic
- Neonates >32 wk gestation
- 10-20 mg/kg/day IV divided q12-24h for at least 2 wk as part of multi-drug regimen
- 1+ mo
- 20 mg/kg/day IV divided q12h for at least 2 wk as part of multi-drug regimen
- Max: 300 mg/dose
- 20 mg/kg/day IV divided q12h for at least 2 wk as part of multi-drug regimen
Special Populations
- Pregnancy Rating: C
- Lactation: Infant risk minimal
- Renal Dosing:
- Adult
- CrCl <50: Consider decreasing dose 0-50%
- HD/PD: No supplment
- Pediatric
- CrCl <50: Consider decreasing dose 0-50%
- HD/PD: No supplment
- Adult
- Hepatic Dosing
- Adult
- Avoid Use
- Pediatric
- Avoid Use
- Adult
Contraindications
- Allergy to class/drug
- IM or SC administration
- Concomitant use with atazanavir, darunavir, fosamprenavir, saquinavir, tipranavir, rilpivirine or elvitegravir/cobicistat
Adverse Reactions
Serious
- Agranulocytosis
- DIC
- Hepatotoxicity
- Nephrotoxicity
- Thrombocytopenia
- Leukopenia
- Anemia
- Porphyria exacerbation
- Erythema multiforme
- Stevens-Johnson Syndrome
- Toxic epidermal necrolysis
- C. Diff associated diarrhea
- Psychosis
- Uveitis
Common
- Reddish-Orange body fluids
- Nausea/vomiting
- Diarrhea
- Headache
- Dizziness
- Fatigue
- Disequilibrium
- Weakness
- Pruritus
- Flushing
- Anorexia
- Abdominal pain
- Dyspnea
- Contact lens staining
Acute Overdose
- Diarrhea is unique to rifampin toxicity in comparison to other antituberculous medications[1]
Antibiotic Sensitivities[2]
Key
- S susceptible/sensitive (usually)
- I intermediate (variably susceptible/resistant)
- R resistant (or not effective clinically)
- S+ synergistic with cell wall antibiotics
- U sensitive for UTI only (non systemic infection)
- X1 no data
- X2 active in vitro, but not used clinically
- X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
- X4 active in vitro, but not clinically effective for strep pneumonia